A Real Problem
As Number of HIV Patients Grows, Tyler’s Two Specialized Doctors Struggle To Keep Up
First in a four-part series
By Coshandra Dillard | Staff Writer
After more than 25 years since its discovery in the U.S., and following countless educational campaigns on prevention of HIV/AIDS, the virus continues to spread. East Texas is no exception. According to the 2009 Texas Integrated Epidemiologic Profile for HIV/AIDS released by the Texas Department of State Health Services, more than 1,100 people are living with the disease in a 14-county area, with more than 300 in Smith County. There are countless others who are unaware of their status, officials say. According to the latest reports, those numbers have risen steadily each year - more than 250 new cases between 2003 and 2007. Because of the trend, agencies and clinics charged with serving HIV patients are scrambling to ensure the immediate and long-term needs of these patients are met.
In Tyler, while primary care physicians may see HIV-positive patients, most end up in the offices of an infectious disease physician who specializes in HIV care. But, there are only two in Tyler, which means the doctors are often stretched to see hundreds of patients from Tyler and the surrounding area. Dr. Richard Yates, one of the infectious disease physicians, said he typically sees about 25 patients twice per week, every other week at Total HealthCare Center, a clinic charged with caring for the underinsured and uninsured. Just last year, an infectious disease physician at The University of Texas Health Science Center relocated, sending some patients to seek care elsewhere. For East Texas patients, the limited number of infectious disease specialists seeing HIV patients could potentially be dangerous, as the aggressive virus must be properly managed. Dr. Kirk Calhoun, president of The University of Texas Health Science Center at Tyler, said the center is actively searching for another physician to fill that gap. "We hope to have another physician recruited in the next six to 12 months," he said. "Keep in mind you may find someone out of state and it could take longer because in order to practice here, they have to have a Texas license.
He added, "We’re very concerned, obviously. We want to make sure the community has adequate care in this area. We have seen some of the patients we can care for but many do require an infectious disease specialist." In the meantime, Dr. Yates and colleague Dr. Steven Hickerson, continue to serve some of those patients, but with limited time at THC, appointments are backlogged. Delayed appointments could mean a delay in receiving HIV medicines or being treated for a secondary infection. Dr. Yates said his practice has since hired a nurse practitioner to help with the load. He said they strive to provide top-notch care to HIV patients, but for about the last 12 months, it has been a challenge. "(THC) has been as accommodating as they can be but they just have the limited ability to help," Dr. Yates said. "There is good news, though, because we’ve asked SHRT (Special Health Resources for Texas) to help open up a comprehensive HIV clinic in Tyler." SHRT is a Longview-based HIV resource center that provides case management, clinical care and education to HIV patients in a 23-county area.
The center has already served some Tyler patients at its Tyler office, but after receiving additional state funding, will offer a weekly clinic at the office. Some patients have traveled via SHRT’s complimentary transportation service to Longview for medical care, dental care and other resources. Establishing a clinic in Tyler would relieve some of the problems with limited access to physicians, officials say. "Despite the current troubles we’ve been having, we’re encouraged there will be excellent comprehensive HIV care in Tyler in the near future," Dr. Yates said. Dr. Bennie Webster, interim executive director at THC, said with budget cuts, lost funding and expensive lab work, the organization is unable to provide extensive care to HIV patients. However, it will continue to provide primary care. Dr. Yates and Dr. Hickerson will begin seeing patients Dec. 9 and each patient will be seen quarterly, at minimum, if they have no complications. "We all saw the need and that’s why we stepped in," said Dr. Phil Farmer, SHRT executive director. "Part of what we are doing with our new grant is we’ll be educating primary care physicians in order to help them understand how to provide day-to-day care for patients with HIV."
Dr. Farmer said in the counties they serve, there are 1,460 people identified to have HIV and they care for about 1,000 of them. He said, however, there are many more that do not know their status. In addition, he said his facility tests about 3,500 people each year for HIV. In 2008 there were 16 new cases and 27 new cases in 2009 to date. "The virus is not going away," he said. At Tyler AIDS Services, officials are trying to bounce back after losing significant grants due to a transition in leadership. The agency serves more than 200 clients who receive food, assistance with bills, HIV education and other services. New executive director, Jeanette Deas Calhoun, said she became enthralled with the mission of TAS. "The passion is there. I was drawn to it," she said. "The passion - it’s personal because I’ve known people who’ve lost the battle."
On Tuesday, TAS will host an event in observance of World AIDS Day. "We’re hoping the event brings an additional emphasis and focus on World Aids Day," she said. "We, too, are concerned about the capacity of care. We’re hoping to draw attention that there is a lot more we have to do." In the meantime, Mrs. Calhoun said she and TAS board members are working to improve services in Tyler. "It’s concerning when you read the stats and it’s really concerning when you hear the myths," Mrs. Calhoun said. "We believe prevention and education is the key and that is the focus of our agency until the cure arrives. We’re feeling better about where we are in terms of what we provide."
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